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Thrombocytopenia Associated With Levodopa Treatment

Vicente Giner, MD; Diego Rueda, MD; Antonio Salvador, MD; Juan Carlos Hernández, MD; María José Esteban, MD; Josep Redón, MD
Arch Intern Med. 2003;163(6):735-736. doi:10.1001/archinte.163.6.735.
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In a recently released review of published case reports, excluding those related to heparin administration, 98 drugs were listed with a definite or probable causal role for drug-induced thrombocytopenia. The most commonly implicated were quinidine, gold salts, and the combination drug trimethoprim-sulfamethoxazole.13 Drug-induced thrombocytopenia is mostly produced by the autoimmune mechanism.4 A short-term drug treatment induction period, averaging 14 days, with a short recovery period after withdrawal of drug treatment, averaging 7 days, have been described.2 Although thrombocytopenia can be severe, major bleeding and death have been reported in only 9% and 0.8% of the cases, respectively, we reviewed in the literature.2 We report the case of a patient with severe thrombocytopenia, probably induced by levodopa, a side effect previously reported in only 1 case.5

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Analytical evolution of thrombocytopenia related to levodopa treatment: Days refer to the admission date. Open downward-pointing arrow indicates the combination drug levodopa-carbidopa instead of the levodopa-benserazide combination; downward-pointing gray arrow, bromocriptine instead of the levodopa-carbidopa combination. The boxes at the top left indicate 1 platelet pooled transfusion at day 4 after admission and 2 platelet pooled transfusions on day 9 after admission.

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